上海地区妊娠期糖尿病孕妇孕前体重指数及孕期体重增加现状分析

Analysis of pre-pregnancy BMI and gestational weight gain of pregnant women with gestational diabetes mellitus in Shanghai

目的:分析上海地区妊娠期糖尿病(GDM)孕妇孕前体重指数(BMI)和孕期增重(GWG)特点。方法:选取2017年7月至2018年7月在上海十家医院规律产检并住院分娩的单胎孕妇共3961例,其中610例GDM孕妇和3351例非GDM孕妇。分析GDM的发病高危因素,比较GDM孕妇和非GDM孕妇孕前BMI、GWG、早中晚孕期增重、妊娠合并症等差异,并将两组GWG与美国科学研究院医学协会(IOM)推荐增重标准进行比较。结果:孕前BMI和年龄是GDM发生的独立高危因素(OR=1.18,95%CI为1.05~1.34;OR=1.09,95%CI为1.06~1.11)。GDM组的孕前BMI值为(22.3±3.4)kg/m 2,高于NGDM组[(21.1±2.7)kg/m 2],两者差异有统计学意义(P<0.05)。GDM组的GWG为(11.9±4.8)kg,明显低于NGDM组[(13.3±4.3)kg]。两组早孕期增重无统计学差异。GDM组的中、晚孕期增重[(5.5±2.4)kg、(4.1±2.4)kg]少于NGDM组孕妇[(6.5±2.7)kg、(4.8±2.5)kg],差异均有统计学意义(P均<0.001)。与IOM推荐孕期增重标准比较,孕前BMI适中、超重的GDM组孕妇中增重偏少者占比均较NGDM组高;NGDM组增重偏多者占比均较GDM组高。结论:孕前超重或肥胖及高龄可导致GDM发生率增加,应对该群体进行孕前指导,合理控制BMI后再备孕。孕中晚期良好的医疗管理可有效控制GDM孕妇的孕期增重,进而减少不良妊娠结局。

Objective:To characterize the pre-pregnancy body mass index(BMI)and the gestational weight gain(GWG)of pregnant women with gestational diabetes mellitus(GDM)in Shanghai.Methods:This study included 3961 single pregnancy women who underwent routine obstetric examinations and gave birth in 10 hospitals of Shanghai from Jul.2017 to Jul.2018.The risk factors of GDM were analyzed,and the pre-pregnancy BMI,GWG,weight gain in first trimester、second trimester、third trimester and pregnancy complications were compared between GDM and non-GDM pregnant women.The GWG of the two groups was compared with the weight gain criteria recommended by the USA Instiute of Medicine(IOM).Results:The study included 610 women with GDM and 3351 women without GDM.Pre-pregnancy BMI and age were independent risk factors for GDM(OR=1.18,95%CI=1.05~1.34;OR=1.09,95%CI=1.06~1.11).The mean pre-pregnancy BMI of the GDM group was(22.3±3.4)kg/m 2,which was higher than that of the NGDM group[(21.1±2.7)kg/m 2],and the difference was statistically significant.GWG of GDM group was(11.9±4.8)kg,which was significantly lower than that of NGDM group[(13.3±4.3)kg].There was no significant difference in weight gain during first trimester between the two groups,while weight gain of the second trimester and third trimester[(5.5±2.4)kg,(4.1±2.4)kg]in GDM group was less than that in NGDM group[(6.5±2.7)kg,(4.8±2.5)kg)(P<0.001).Compared with 2009 IOM gestational weight gain recommendation,GDM group were more prone to have inadequate weight gain,while NGDM group were more prone to have excessive weight gain.Conclusions:Overweight or obesity before pregnancy and advanced age can increase the incidence of GDM.Therefore,pre-pregnancy counseling should be conducted for this group to reduce BMI before pregnancy.Good medical management in the second and third trimester can effectively control the weight gain of women with GDM,thus reducing adverse pregnancy outcomes.